Use of Negative Pressure Wound Therapy in Treatment of Enteroatmospheric Fistulas : Critical Review of the Literature

There are a few situations in surgery as challenging as management of open abdomen (OA). Probably the worst and most devastating complication of OA is an exposed (enteroatmospheric) fistula. Such patients have high mortality and morbidity rates. Mortality rates in patients with gastrointestinal fistula is 5-20% increasing up to 66% in the setting of OA. The most important factor attributable to such high mortality rates is septic response to bacterial burden arising from stool content in the open wound. Surgical closure of the fistula is scarcely successful and diversion of the enteral content by means of standard wound care options is ineffective and insufficient. Introduction of novel wound treatment options such as negative pressure wound therapy (NPWT) opened new horizons in the management of OA and its complications. Up to this date no method was accepted as a standard, rather, all of them bear signs of improvisation and creativity. Authors in the article reviewed available up-to-date literature confronting it with their own experiences with the aim of aggregation of information, comparing the methods, and finding the most feasible method and direction for future development of NPWT in treatment of enteroatmospheric fistulas in OA.